Video 6:43
Doctor champions treatment for menopause

The founder of Western Australia's first menopause clinic Dr Margaret Smith says that although studies have linked hormone replacement therapy to breast cancer, the benefits outweigh the risks.

Transcript

When a study linked hormone replacement therapy to breast cancer in 2002, women around the world ditched the treatment in droves. Although the validity of that research has since been questioned, HRT's image has never fully recovered.

Many doctors remain reluctant to prescribe it and there have been a number of studies since linking the treatment to various types of cancers. But one practitioner who is determined to see HRT revived is the founder of WA's first menopause clinic. And she believes that for many women the benefits outweigh the risks. Claire Moodie reports on the doctor who has become known as Mrs Menopause.

CLAIRE MOODIE, REPORTER: It's another busy day at the clinic for Margaret Smith.

MARGARET SMITH, GYNAECOLOGIST: Good morning. Judy. How are you today?

CLAIRE MOODIE: After 30 years in the business, this veteran gynaecologist is still in high demand.

MARGARET SMITH: Some of them are so desperate, you know, whatever I told them they would do it.

ROSE LOWE, PATIENT: Well I didn't know what was wrong with me. You know, I thought I was losing my marbles.

REINA NAPPER, PATIENT: I was angry. I didn't know why I would get so angry all the time. I wanted to cry.

CLAIRE MOODIE: Specialising in the menopause, Dr Smith has become a saviour for many women of a certain age

ROSE LOWE: The panic was pretty intense, the inability to think clearly.

CLAIRE MOODIE: And a saviour for the partners too.

ROBIN NAPPER: You can always predict with your partner what is going to upset them. But once she kicked into this menopause I didn't know when she was going to blow up over something.

CLAIRE MOODIE: But it's these classic symptoms of menopause that Margaret Smith believes too many women today are enduring without adequate treatment.

MARGARET SMITH: I am afraid we have gone backwards. When I first started the menopause work here at King Edward in 1978, nothing was then available. And women just had to put up and shut up as they say.

But once we opened up the clinic and women started to come, the relief of their hot flushes, the fact that sex wasn't so painful, was so miraculous that everybody wanted to go on it.

CLAIRE MOODIE: It was HRT hormone replacement therapy which became known as a panacea for women struggling with the change.

DR ROSANNA CAPOLINGUA, AUSTRALIAN MEDICAL ASSOCIATION SPOKESWOMAN: Women were made to feel that when they turned 40 they were going to be oestrogen depleted and they needed to go and get HRT in order to stay young and youthful and functional and to stave off all the nasty things that were going to happen in menopause

CLAIRE MOODIE: But it all came to an abrupt halt with a release of an American study in 2002.

ABC NEWS REPORTER, NEWS REPORT 2002: It found that out of every 10,000 women taking the combined oestrogen and progestin HRT eight more than average would develop breast cancer. Seven more would have heart attacks.

TELECOMMUNICATIONS WORKER: This information does not mean that you're going to get breast cancer.

HEALTH PROFESSIONAL, 7.30 REPORT 2002: Absolutely no need to panic.

No need to throw the tablets down the toilet or throw them at your doctor as some people might wish to do.

CLAIRE MOODIE: Six out of ten women weren't convinced taking themselves off the treatment. And eight years later Margaret Smith says Australia still is in an anti HRT era.

MARGARET SMITH: They're not getting the other side of the story. The positive effects are not in headlines in the papers. I mean most HRT stuff gets page 3 on the right hand side where they see it as soon as they open up. The negative stuff.

CLAIRE MOODIE: She spent the last few years trying to set the record straight, even publishing a book on the pros and cons of HRT.

Margaret Smith says the US research tested the wrong women at the wrong age. Most were in their mid 60s.

MARGARET SMITH: Women back at 50 just starting menopause who are not smokers, who are not overweight, not having high cholesterol or anything, perfectly safe to give them hormones.

CLAIRE MOODIE: And she is not alone. Other experts are also concerned that many women are missing out on what they call the safe window of opportunity.

PROFESSOR BRONWYN STUCKEY, KEOGH INSTITUTE FOR MEDICAL RESEARCH: Some doctors can be very defensive about it. And, sure, it keeps them out of trouble but it doesn't always help the patient.

CLAIRE MOODIE: But not everyone's unhappy. Prominent Perth GP Rosanna Capolingua says there are alternatives to HRT and she welcomes the balance in today's debate.

DR ROSANNA CAPOLINGUA: You almost felt as if you weren't part of the HRT club that you were missing out and you were going to allow yourself to become a wrinkled prune.

Now, we've got the ability to have the discussion, the controversies about HRT and its relative risk in individuals. The myths that have been busted about the benefits of HRT and heart disease has allowed women to come in and talk to their doctor and feel that they can have a right to choose not to have HRT.

CLAIRE MOODIE: The controversy surrounding hormone therapy is reflected in pharmacies where there are few far fewer brands to use from and only patches remain on the Pharmaceutical Benefits Scheme.

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CLAIRE MOODIE: What most experts seem to welcome is that menopause is no longer taboo subject and that women have the right to choose what treatment, if any, they prefer.

DR ROSANNA CAPOLINGUA: Menopause itself is a natural process. It's how we are meant to be.

So if we want to be natural, then this is it, I'm afraid, such as it is.

CLAIRE MOODIE: For Margaret Smith's patients at least they've weighed up the risks and the benefits and have opted for HRT.

ROSE LOWE: I'm calmer in myself, sleeping better, certainly not panicky. And I think more, although you wouldn't think so with this interview, but my thoughts are clearer!

ROBIN NAPPER: For me it was the mood swings. They just stopped, when Reina came back to being the woman I married and the woman I love.

CLAIRE MOODIE: Dr Smith aims to retire in two years, just in time for her 80th birthday. Before then she's got a second book to publish and a message to get across based on three decades of personal experience.

MARGARET SMITH: In fact, I think it would be safe to take practically forever. I am going to take mine forever. The last thing they do when they put me in the coffin is take my patch off.